Maternal health: partograph interpretation: practice question

A PSM question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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PSM · Maternal health: partograph interpretation

Sample item

In a primigravida, the active phase of labour is plotted on the WHO partograph from 4 cm dilatation at 08:00. By 14:00 the cervix is only 5 cm dilated, with adequate contractions and a vertex presentation. How should this be interpreted?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. The action line has been crossed, so labour needs evaluation for obstruction and a decision about augmentation or caesarean section

The alert line starts at 4 cm and rises at 1 cm per hour, and the action line lies 4 hours to its right. A cervix of 5 cm should have been reached at 09:00 on the alert line, so 14:00 is 5 hours beyond it, past the action line at 13:00. This indicates slow progress that needs assessment of the cause and active management.

Option by option

  • A. The action line has been crossed, so labour needs evaluation for obstruction and a decision about augmentation or caesarean section (correct)

    Progress to the right of the action line mandates assessment and intervention.

  • B. Only the alert line has been crossed, so observation can continue for another 4 hours

    The action line, 4 hours to the right of the alert line, was reached at 13:00 for the 5 cm point.

  • C. Labour is normal because the cervix is to the left of the alert line

    Progress that has fallen so far behind is to the right, not left, of the alert line.

  • D. She is in the latent phase, which can last up to 8 hours

    The partograph is started at 4 cm, which marks the beginning of the active phase.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this PSM question

What is the answer to this PSM question?

The best answer is A, The action line has been crossed, so labour needs evaluation for obstruction and a decision about augmentation or caesarean section. The alert line starts at 4 cm and rises at 1 cm per hour, and the action line lies 4 hours to its right.

Why is "Only the alert line has been crossed, so observation can continue for…" not the answer?

The action line, 4 hours to the right of the alert line, was reached at 13:00 for the 5 cm point.

Why is "Labour is normal because the cervix is to the left of the alert line" not the answer?

Progress that has fallen so far behind is to the right, not left, of the alert line.

Why is "She is in the latent phase, which can last up to 8 hours" not the answer?

The partograph is started at 4 cm, which marks the beginning of the active phase.

What concept does this question test?

It tests Maternal health: partograph interpretation in PSM. A cervix of 5 cm should have been reached at 09:00 on the alert line, so 14:00 is 5 hours beyond it, past the action line at 13:00. This indicates slow progress that needs assessment of the cause and active management.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Maternal health: partograph interpretation?

Practise biostatistics with small calculations until sensitivity, predictive values and risk measures are automatic. Then use the flashcards and the other PSM questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.